“Balance”

Jim Cleary, MDAssociate Professor of Medicine

Director, Palliative Care Medicine, UW Hospital & ClinicsDirector, WHO Collaborating Center for Pain Policy and Palliative Care

Establishes a Framework to:

1.Prevent abuse and diversion, and

2.Ensure the availability of drugs for medical purposes

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“Balance”

“the medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering… adequate provision must be made to ensure the availability of narcotic drugs for such purposes.” (Preamble, p. 13)

“The low levels of consumption of opioid analgesics for the treatment of pain in many countries, in particular in developing countries, continue to be a matter of serious concern to the Board.

The Board again urges all Governments concerned to…take steps to improve the availability of those narcotic drugs for medical purposes…”

(INCB 2007 Annual Report, p. 20)

INCB Concern

Why is opioid use so low? 1995 Survey of government drug

control authorities – 65 countries

Impediments to opioid availability:Fear of addictionLack of trainingExcessively restrictive laws and

regulationsFear of legal consequencesInsufficient amount of opioidsCost of opioidsInadequate health care resourcesLack of national policy, guidelines

International Narcotics Control Board. (1996). Report of the International Narcotics Control Board for 1995: Availability of Opiates for Medical Needs. New York, NY: United Nations.

Why is opioid use so low?

2006 Survey of Health care workers, and hospice/PC staff in Asia, Africa and Latin America

Adams, V. (2007). Access to Pain Relief – an essential human right. Help the Hospices, Worldwide Palliative Care Alliance.

Barriers to accessing oral morphine: Excessively strict national drug laws and regulations; Fear of addiction;Poorly developed health care systems;Lack of knowledge

Barriers

1) Opioid Regulatory Policy

2) Drug Distribution System

3) Cost of Opioid Analgesics

4) Knowledge & Attitudes

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For governments and health professionals

Explains need, rationale and imperative

16 criteriaSimplified Checklist22 Languages

Achieving Balance in National Opioids Control Policy: Guidelines for Assessment (2000)

“Balance” is the Fundamental Principle

National policy should establish a drug control system that prevents diversion and ensures adequate availability for medical use

Drug control measures should not interfere with medical access to opioid

Документ № WHO/EDM/QSM/2000.4СТАТУС ДОКУМЕНТА: ЗАГАЛЬНИЙ

WORLD HEALTH ORGANIZATIONВСЕСВІТНЯ ОРГАНІЗАЦІЯ ОХОРОНИ ЗДОРОВ’Я

НАРКОТИЧНІ ТА ПСИХОТРОПНІ ПРЕПАРАТИ

ДОСЯГНЕННЯ ВІДПОВІДНОСТІНАЦІОНАЛЬНИХ ПОЛІТИК

КОНТРОЛЮ ЗА ЗАСТОСУВАННЯМ ОПІОЇДІВ

РЕКОМЕНДАЦІЇ ЩОДО ОЦІНЮВАННЯ

WORLD HEALTH ORGANIZATION

ВСЕСВІТНЯ ОРГАНІЗАЦІЯ ОХОРОНИ ЗДОРОВ’Я

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www.painpolicy.wisc.edu

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WHO Public Health Model__________________________

DrugAvailability Education

Policy

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Consumption of Morphine 1980 - 2003 East vs. West Europe (mg/capita/yr)

mg/capita

Joranson,

Lancet 2006

World Health Organization Collaborating Centerfor Pain

Policy and Palliative Care